How does Norse work?
Norse feedback adapts to every client. This is possible using advanced algorithms that identify which clinical areas and issues are the most relevant for the client. For example, we do not want to ask a series of questions about alcohol consumption to clients that do not drink. Norse feedback focuses on areas that are relevant to the individual and at the same time includes control questions over a wider range of symptoms and resources. Continuing from the example above, if the client reports a change in their drinking habits, the system will automatically register this and provide more drinking-related questions.
How to use Norse?
There are many ways you can use Norse together with your client. Much of this depends on clinical judgement and the approach being used for treatment. There is only one critical component: the therapist needs to review the report before the session, and acknowledge the clients for the feedback they have given. Patients need to see that their effort in responding to the assessment is important to their treatment. Failure to acknowledge this can be detrimental to the therapeutic alliance, and will eventually result in the patient no longer completing the assessment. In practice, it is best to encourage patients to routinely complete the assessment. When initially explaining Norse Feedback to a patient, it is often important to remind the patient why the information is important for your work, and to involve them in the process of reviewing results.
Examples of use: You can actively use Norse within every session to monitor the treatment and the development of a disorder. With brief treatments, you can choose to give the assessment before the first and last session. The provider can show and talk through the whole report with the patient, or just refer to specific elements within it. Make an agreement with the client on how to best use Norse.
Purchase and implementation
If you consider Norse a clinical feedback tool that meets your needs, please contact us. Our typical implementation follows set steps: initially we conduct a survey of the experience and motivation of the staff regarding use of clinical feedback system. We do this to ensure a good implementation process, in which we have, in advance, mapped out strengths and potential challenges in your setting, so that we can resolve them effectively.
Following the survey, we provide a short report of our findings, and recommendations to help you determine whether to move forward with implementation. Once an agreement is signed, we work collaboratively to establish a culture where clinical feedback is a natural part of your practice. All of our implementation teams are led by clinicians, who have experience using Norse Feedback with their own patients.
Training
We offer a basic training for employees as part of implementation. Here we review the general use of clinical feedback systems, how the Norse assessment is built, how to use our software, as well as training in how to introduce and interpret the feedback together with the patient. After the training, the Norse team will be available for participation in discussion meetings, support over web and by telephone.
Routine use
Norse Feedback is a license-based solution where we estimate the volume of treatment hours during one week. This method motivates our partner to offer Norse Feedback to as many patients as possible, as often as possible. This is the best supported method in the research literature for effective use of feedback systems. It is also in line with recommended procedures for strong implementation and organizational development.
The method
Norse started as an initiative between Christian Moltu and Samuel Nordberg. They wanted to develop a feedback system that was dynamic and customizable to the individual, while also having strong psychometric properties. They saw the need to consider patients’ suffering in a more dimensional and broad manner; as compared to the more traditional categorical understanding. They also believed it was critical to strengthen the patient’s ability to voice feedback to their provider. Based on this idea, they asked different clinicians and patients about their needs and wishes for a feedback system. As a direct result of this study, Norse 1.0 was developed and implemented in several psychiatric departments in Health Førde throughout 2015. After using the system for two years, feedback from patients, researchers, and clinicians was compiled to carry out the first revision of Norse.
Using psychometric information from item response theory and focus group interviews with clinicians who had used Norse, the feedback system was further developed. With item-response theory, we evaluate every single item to see how much information it provides, and whether it requires adjustment. By mapping this in depth, as well as working closely with clinicians and patients who offer both clinical and personal experience on each item, we continuously focus on adaptation and improvement. We believe it is vitally important to conduct an annual review of Norse Feedback in which we continuously focus on incremental improvement in order to offer the most updated and time-sensitive feedback system. This means that Norse will never be fully developed, but is constantly evolving.
Technology
Norse has never been available on paper, which has freed us from limitations of 1st generation feedback tools. Today, Norse is delivered over the Checkware assessment service. From January 2019 it will also be delivered on its own independent platform. By developing our own software, we can develop functionality that provides patients, clinicians, and leaders with better information. After the patient has completed the assessment, a clinical report is available for the therapist to review and use in consultation together with the patient.
Assessment results are anonymously stored in a secure database which we use for quality improvement. As our dataset grows, we are developing predictive analytics and precision medicine tools designed to leverage large amounts of patient-specific data for clinical insights.
Research projects
Ongoing research with Norse Feedback:
- How do clients experience the use of Norse within psychotherapy?
- Clinical feedback, environmental therapy, and user experiences in in-patient clinic
- Implementation of self-learning dynamic clinical system in a regular clinic
- Norse as an improved method for treating human beings with obesity.
FAQ
The patient has not completed a Norse this week, what do I do?
As long as the patient is registered, you do not need to do anything. There will always be one assessment ready for the patient. If this is not answered, it will automatically move to the next week. It can be a good idea to remind the patient of the importance of the use of the clinical feedback tool.
The patient does not want to use Norse, what do I do?
Use of Norse is voluntary in most settings, but we encourage you to provide the patient with your reasoning for why you think it is important to treatment. It is particularly important to inform the patient about the benefits of using a clinical feedback system, and that their information is completely safe.
The patient does not want to use Norse every week, what do I do?
We recommend using Norse before every session, especially early in the treatment. If the patient does not want this, one may propose that the patient answer the assessment every second week, but this is not recommended because it’s harder to track and vital information is lost.
I want to see the actual answers the client has given. How can I find this?
It varies if both the visual report and the actually response report enters the health records. This depends on decisions within the single healthcare services. If only the visual report is available, one can log in to CheckWare and see the responses there. On our software, the answers will automatically be available if you click on the dimension that you are interested in.
The patient has reported elevations on suicide items, what should I do?
All the feedback you find in Norse is communication from the patient. If the patient endorses one or more suicide items, it is highly recommended that you use that information to broach the subject gently with the patient. The suicide dimension in Norse should not replace a clinical risk assessment for suicidality. Some patients may be chronically suicidal. In this case, work with your patient to understand what responses you should follow up on.
I do not think the clinical report matches my clinical evaluation. What does this mean?
There are many answers to this question. In these situations, it is important to talk to the patient and find a common understanding of the Norse results. Some patients over- or under-endorse on digital assessments. Some patients may not want to answer truthfully, while others may have difficulty interpreting some questions. The key here is to follow up with the patient and make sure you have a shared understanding of the discrepancy.
Treng eg å bruke andre kartleggingsverkty når eg brukar Norse?Do I need to use other clinical assessments when I use Norse?
Norse is a clinical feedback system that provides information from the patient over a wide range of areas. This does not exclude the use of other screening tools or surveys.
Curious about Norse?
Call us! Many clinics and clinicians want to implement a clinical feedback system. We are happy to tell you more about Norse and how it might fit for your setting. We offer a non-binding consultation and a presentation of Norse Feedback to all interested parties.